Long-term effectiveness of bisoprolol in patients with angina: A real-world evidence study.

A cohort analysis using UK Clinical Practice Research Datalink (CPRD) was performed to compare the effects of bisoprolol, other ß-blockers, and drugs other than ß-blockers on the long-term risk of mortality and cardiovascular events in patients with angina. Adult patients first diagnosed with angina from 2000 to 2014, with ≥365 days of registration to first angina diagnosis and initiating monotherapies of bisoprolol, other ß-blockers, or drugs other than ß-blockers within 6 months of angina diagnosis were included. Incidence rates for each treatment cohort were compared using adjusted hazard ratio (HR) and 95% confidence intervals (CI) obtained from Cox regression analyses. Overall, 987 patients were treated with bisoprolol, 1348 with other ß-blockers and 5272 with drugs other than ß-blockers. Over the total follow-up (≤14 years), the HR of bisoprolol versus other ß-blockers and drugs other than ß-blockers for mortality was 0.45 (95% CI: 0.34-0.61) and 0.50 (95% CI: 0.38-0.66), respectively. The HR of bisoprolol versus other ß-blockers for angina was 0.58 (95% CI: 0.50-0.68) and versus drugs other than ß-blockers was 0.77 (95% CI: 0.68-0.88), respectively. For myocardial infarction, the HR of bisoprolol versus drugs other than ß-blockers up to 14 years was 0.34 (95% CI: 0.23-0.52) and versus other ß-blockers up to 5 years was 0.45 (95% CI: 0.27-0.75). At 5 years, the HR of bisoprolol versus other ß-blockers, and drugs other than ß-blockers, for arrhythmia was 0.60 (95% CI: 0.35-1.0) and 0.61 (95% CI: 0.40-0.93), respectively. In conclusion, long-term significant reduction in the risk of mortality and various cardiovascular events with bisoprolol versus other ß-blockers, and drugs other than ß-blockers, confirm treatment guidelines recommendation that bisoprolol is particularly well suited as the first-line treatment of angina in primary care.

Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon

Background A better knowledge of the burden and risk factors associated with severity due to spider bites would lead to improved management with a reduction of sequelae usually seen for this neglected health problem, and would ensure proper use of antivenoms in remote localities in the Brazilian Amazon. The aim of this study was to analyze the profile of spider bites reported in the state of Amazonas in the Western Brazilian Amazon, and to investigate potential risk factors associated with severity of envenomation. Methodology/Principal Findings We used a case-control study in order to identify factors associated with spider bite severity in the Western Brazilian Amazon from 2007 to 2014. Patients evolving to any severity criteria were considered cases and those with non-severe bites were included in the control group. All variables were retrieved from the official Brazilian reporting systems. Socioeconomical and environmental components were also included in a multivariable analysis in order to identify ecological determinants of incidence and severity. A total of 1,181 spider bites were recorded, resulting in an incidence of 4 cases per 100,000 person/year. Most of the spider bites occurred in males (65.8%). Bites mostly occurred in rural areas (59.5%). The most affected age group was between 16 and 45 years old (50.9%). A proportion of 39.7% of the bites were related to work activities. Antivenom was prescribed to 39% of the patients. Envenomings recorded from urban areas [Odds ratio (OR) = 0.40 (95% CI = 0.30-0.71; p<0.001)] and living in a municipality with a mean health system performance index (MHSPI > median [OR = 0.64 (95% CI = 0.39-0.75; p<0.001)] were independently associated with decreased risk of severity. Work related accidents [OR = 2.09 (95% CI = 1.49-2.94; p<0.001)], Indigenous status [OR = 2.15 (95% CI = 1.19-3.86; p = 0.011)] and living in a municipality located > 300 km away from the state capital Manaus [OR = 1.90 (95% CI = 1.28-2.40; p<0.001)] were independently associated with a risk of severity. Living in a municipality located > 300 km away from the state capital Manaus [OR = 1.53 (95% CI = 1.15-2.02; p = 0.003)] and living in a municipality with a MHSPI <median [OR = 1.91 (95% CI = 1.28-2.47; p = 0.002)] increased the odds of antivenom underdosage. Conclusions Spider bites is prevalent across the study region with a higher incidence in the rainy season in rural areas. Spider bites can be painful and lead to local manifestations but rarely result in life-threatening envenoming. Major local complications were dermonecrosis and secondary infection in cases diagnosed as Loxosceles bites. Based on the correlations shown here, envenomings occurring in remote rural areas, Indigenous status and living in a municipality located >300 km away from the state capital Manaus could be contributing factors to higher severity of spider envenomings in this area, as well as to antivenom underdosage

A systematic review of evidence to inform HIV prevention interventions among men who have sex with men in Europe.

An estimated 42% of all newly diagnosed HIV cases in Europe in 2013 were transmitted during sex between men. This review was performed to identify and describe studies evaluating the efficacy and effectiveness of HIV prevention interventions among men who have sex with men (MSM), in relation to implementation data from European settings. A systematic search was performed individually for 24 interventions.Data were extracted from studies including efficacy or implementation data from European settings,appraised for efficacy, implementation and plausibility, and assigned a grade (1-4) according to the Highest Attainable Standard of Evidence (HASTE)framework. Four interventions (condom use, peer outreach,peer-led groups, and using universal coverage of antiretroviral treatment and treatment as prevention)were assigned the highest HASTE grade, 1. Another four interventions were assigned 2a for probable recommendation, including voluntary counseling and testing for HIV, using condom-compatible lubricant,using post-exposure prophylaxis, and individual counselling for MSM living with HIV. In addition, seven interventions were assigned a grade of 2b, for possible recommendation. Encouragingly, 15 interventions were graded to be strongly, probably or possibly recommended.In the relatively resource-rich European setting, there is an opportunity to provide global leadership with regard to the regional scale-up of comprehensive HIV prevention interventions for MSM.

Field performance of a rapid point-of-care diagnostic test for antenatal syphilis screening in the Amazon region, Brazil.

We evaluated an immunochromatographic point-of-care (POC) syphilis test in 712 pregnant women under field conditions in remote communities of the Amazon region (Brazil), and identified risk factors for syphilis. Women were screened by POC test using whole blood obtained by fingerprick, the fluorescent treponemal antibody absorption (FTA-Abs) test as the gold standard and the Venereal Diseases Research Laboratory (VDRL) test to determine test performance in active syphilis. Multivariate analysis was conducted to identify factors associated with syphilis infection. Among women, 2.2% had syphilis (positive FTA-Abs) and 0.8% active syphilis (FTA-Abs and VDRL positive). In all, 2.2% of samples were positive by the POC test. The sensitivity, specificity, positive and negative predictive values were 62.5% (95% confidence interval [CI]: 38.6-81.5), 99.1% (95% CI: 98.1-99.6), 62.5% (95% CI: 38.6-81.5) and 99.1% (95% CI: 98.1-99.6), respectively. The POC test identified 62.5% (10/16) of syphilis cases, 66.7% (4/6) of active syphilis cases and all high-titre syphilis cases (VDRL > 1:8). Older age was associated with syphilis infection. The rapid test performed moderately well as a screening tool for low-risk populations. This combined with on-site testing and same day treatment could expand antenatal syphilis screening programmes in distant communities characterized by difficult access to antenatal services and infrequent clinical follow-up visits.

Clinic-based evaluation of a rapid point-of-care test for detection of Chlamydia trachomatis in specimens from sex workers in Escuintla, Guatemala.

We evaluated a rapid point-of-care test for the detection of Chlamydia trachomatis in specimens from 278 sex workers attending sexually transmitted infection clinics in Guatemala. The sensitivity and the specificity of the test compared to the results of PCR were 62.96% and 99.60%, respectively. The test performed moderately well as a screening tool in a context in which clinical follow-up visits are infrequent.

Field evaluation of the performance and testing costs of a rapid point-of-care test for syphilis in a red-light district of Manaus, Brazil.

OBJECTIVES: To assess the performance, usefulness and cost of a rapid treponemal antibody assay (VisiTect Syphilis) to detect syphilis in high risk populations. METHODS: People who attended STI clinics in Manaus, Brazil, were screened for syphilis using the fluorescent treponemal antibody absorption (FTA-Abs) test and a non-treponemal test (Venereal Diseases Research Laboratory (VDRL)), and for HIV. Finger prick blood samples were tested with VisiTect Syphilis. The rapid test was evaluated against the reference FTA-Abs and for its usefulness in detecting active syphilis (FTA-Abs and VDRL positive). Operational performance was assessed through providers' and patients' interviews. An economic evaluation was conducted from the provider's perspective. RESULTS: 510 patients (60% men) were enrolled, of whom 13 (2.5%) were HIV-1 seropositive. Syphilis prevalence (FTA-Abs) was 18% and active syphilis prevalence was 7.5%. 11% (57/506) of samples were positive by VisiTect. The sensitivity, specificity, positive and negative predictive values of VisiTect Syphilis were 57% (95% CI 45.8 to 66.7), 99% (95% CI 97.0 to 99.6), 91% (95% CI 80.0 to 96.7) and 91% (95% CI 88.0 to 93.5), respectively. VisiTect Syphilis identified 79% (30/38) of active syphilis cases. The cost per case of syphilis was $16.8 for VDRL, $33.2 for low cost and $56.3 for high cost VisiTect Syphilis; the cost per case of active syphilis was $21.3, $57.5 and $97.6, respectively. Patients identified finger prick pain and preference for venous blood collection as minor barriers to test use. CONCLUSION: VisiTect Syphilis had low sensitivity in field use and was less cost effective than conventional VDRL. However, rapid and correct identification of a high proportion of active syphilis cases combined with operational characteristics suggest a role in high risk populations.

Clinical and virological effects during two years of ongoing adefovir dipivoxil in the treatment of lamivudine-resistant chronic hepatitis B infection.

OBJECTIVE: Our aim was to evaluate the efficacy and safety of adding adefovir to lamivudine therapy for hepatitis B virus (HBV)-infected patients resistant to Ramivudine. PATIENTS AND METHODS: Among 17 studied patients, 7 had chronic active HBV infection and 10 were posttransplant with HBV infection (9 with de novo HBV). They received lamivudine plus adefovir therapy for 2 years. We assessed reductions in serum HBV-DNA and alanine aminotransferase (ALT) levels, loss of HBeAg (in HBeAg+ cases), and HBsAg clearance. RESULTS: A virological response, as defined by HBV-DNA below the cut off by hybridization, was observed in 12 (70.6%) patients and loss of HBeAg in 4 (44.4%) of the 9 initially HBeAg-positive cases. A biochemical response, defined as a decreased serum ALT to the normal range, occurred in 4 (26.7%) patients. Median serum creatinine increased in 3 of 15 (20%) patients, excluding those on hemodialysis. There were two noteworthy cases of sustained HBsAg seroconversion with adefovir (11.8%): one patient with de novo HBV infection posttransplantation and positive hepatitis C virus-RNA serology, and one patient with decompensated HBV cirrhosis in whom viral replication ceased, making him eligible for transplantation. CONCLUSIONS: Currently, adefovir is an effective rescue therapy that broadens the existing range of options for patients with lamivudine-resistant chronic hepatitis B infection, particularly those with decompensated cirrhosis awaiting a liver graft, and those with recurrent posttransplantation HBV. The relatively small biochemical response seen in these patients may be attributable to the high prevalence of concomitant hepatitis C virus infection (41%).

Inelastic electronic excitation and electron transfer processes in collisions between Mg(31S0) atoms and K+(1S0) ions studied by crossed beams in the 0.10-3.80-keV energy range.

Inelastic and charge-transfer excitation processes in collisions between ground-state neutral Mg atoms and K+ ions have been studied by means of a crossed molecular-beam technique. Decay fluorescent emissions from Mg(3 1P1),Mg(4 3S1), and Mg(3s(1)3d(1), 3(3)D3,2,1) as well as the phosphorescent emission due to Mg(3 3P1) have been observed from excited Mg atoms and the charge-transfer emission decays from K(4 2P 3/2,1/2), K(5 2P 3/2, 1/2), K(6 2S 1/2), and K(4 2D 5/2, 3/2) for excited K atoms. The corresponding absolute cross-sections values versus collision energy functions were determined in the 0.10-3.80 keV laboratory energy range. In order to interpret the experimental results, accurate ab initio full configuration-interaction calculations using pseudopotentials have been performed for the (Mg-K)+ system, giving a manifold of adiabatic singlet and triplet potential-energy curves correlating with the different collision channels, which allow a qualitative interpretation of the emission excitation functions measured for the different processes studied. A comparative study with other Mg-alkali ion systems previously studied is also included.

Electronic excitation and charge transfer processes in collisions between Mg(3(1)S0) atoms and Rb+(1S0) ions in the 0.07-4.00 keV energy range.

Inelastic collision processes between neutral Mg atoms and Rb(+) ions, both in their ground states, have been studied by means of a crossed molecular beam technique measuring the decay fluorescence of the excited species formed. Emissions corresponding to Mg(3 (1)P(1)), Mg(3 (3)D(3,2,1)), and Mg(4 (3)S(1)), formed by direct target excitation, Rb(5 (2)P(3/2,1/2)), Rb(6 (2)P(3/2,1/2)) produced by electron capture and also the phosphorescent emission due to decay of Mg(3 (3)P(1)), have been detected and the corresponding absolute cross-section values measured both as total values and resolved into their J states. No polarization measurements could be made. Ab initio calculations using pseudopotentials have been performed and from these a manifold of adiabatic energy curves correlating with the different entry and exit channels have been obtained, allowing to propose a qualitative interpretation of the results, such as the shape of the cross section vs energy for different transitions and the oscillating nature of the branching ratios due to interference effects.

Bacteriemia, espondilodiscitis y artritis por estreptococo del grupo G en un paciente sin inmunodeficiencia conocida / Bacteriemia, spondylodiscitis and group B streptococcus arthritis in an adult without known immunodeficiency

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